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People in glass houses


People in glass houses

The CCA’s lobbying for local pharmaceutical committees to downsize and merge is as predictable as it is disappointing, says our anonymous correspondent

It will soon be five years since then chief executive of the Pharmaceutical Services Negotiating Committee set the ball rolling on the ‘Wright Review’, which would lead to the Review Steering Group (RSG) and morph into the Transforming Pharmacy Representation Programme (TAPR). Simon Dukes has since moved on and the PSNC has a shiny new name, but some things remain constant – in this case, the twice-yearly demand for the contractor levy.

Landing on the proverbial doormat this year will be a cumulative bill for some £4.8 million in funding for the national negotiator – a whacking £1.5m, or 45 per cent increase from prior to the review. That figure is just for Community Pharmacy England’s role; contractors will be paying the same amount and more once the cost of the local pharmaceutical committees is factored in, meaning that the levy for the average contractor will be in the ballpark of £1,000 to £1,500.

That’s a sizeable sum for sure – but is it value for money? The Company Chemists’ Association (CCA) is of the view that it is not and is lobbying for local committees to downsize and merge. This is a drum beat we have heard before, but its resurgence is as predictable as it is disappointing. It was Dukes who triggered the Wright Review as a response to a sequence of shockingly disappointing contract negotiations. The consensus was that things could not carry on as they were and the contrast between the investment in primary care generally and the lack of investment in community pharmacy was stark. Government was openly saying it saw no financial future in pharmacies dispensing medicines.

Professor Wright’s Review was damning in its conclusion. The negotiating bit of the PSNC (arguably it’s raison d’etre) was not fit for purpose. Compared to the equivalent function at the British Medical Association, it was underfunded, under-resourced and lacking in key skills. Significant investment would need to be made to have any hope of correcting course.

And so here we are, five years on, with Community Pharmacy England now £1.5m a year better off. What will it be doing with these riches? To a large extent, that remains unclear. There has been the odd announcement of new roles – including a local policy manager to help deliver the ‘vision’, but this all seems like window dressing around the cash grab. Where there has been clarity is an insistence (openly from the CCA and implicitly from the national negotiator) that only they represent value for money and LPCs do not.

One persistent theme of this has been merging LPCs into bigger, more streamlined organisations that better align with health economies. At the turn of the century, there were more than 80 LPCs, with some representing fewer than 50 contractors. There are now 55 and CPE has been open that it would prefer there to be 42 – matching the geography of the integrated health boards.

In principle this seems uncontroversial, sensible even. Yet although these NHS geographies seem fixed, they are often in flux, subject to the winds of political change and local government devolution. Contrast that with the often long-standing relationships between local representatives and commissioners which can stretch back 20 or 30 years, or to put that in context, five NHS re-organisations ago.

It is also worth considering that one integrated health care board can have wildly changing demographics, covering both densely urban and wide areas of rurality. Pharmacies in these areas often have significantly different support needs and the LPC infrastructure has developed over time to cater and specialise for the needs of its contractors.

On a more pernicious level, the most recent missive from CPE Towers was directed at LPC treasurers, a seemingly innocuous questionnaire about reserves – oh, and the specific remuneration details of the LPC employees.

This is not new, but it comes at a time when colleagues in LPCs tell me they are feeling increasingly frustrated by the tone of the rhetoric coming from the CCA in particular and CPE in general. There is no doubt that effective representation, locally and nationally, is hard, complex and expensive. Yet it is time that the CCA and the its representatives on the CPE committee remember that it was their failures that led to the repeated and damaging national contract funding.

Local committees have always been subject to the scrutiny of their contractors, and have to repeatedly deliver value – something proven time and again. Why then this increase in rhetoric? Perhaps it’s the realisation that with the rationalisation of the multiple estate and the demise of LloydsPharmacy, there is no block vote for the multiples in many LPCs. Shouting and throwing stones is all the CCA has left. Someone needs to remind it that people in glass houses shouldn’t throw stones.

Outsider is a community pharmacy commentator

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